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Survival analysis of patients with Hodgkin lymphoma who failed high dose chemotherapy and autologous stem cell transplant

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Abstract

Hodgkin lymphoma (HL) patients failing after high dose chemotherapy (HDC) and auto-SCT have a poor outcome. Some patients may still benefit from further treatments. From 1996 to 2016, 137 HL patients (39.5%) out of 347 transplanted experienced post auto-SCT failure. Males/female 61%:39%, median age at auto-SCT 23.4 years and median follow-up 55.6 months (9–153). Type of failure was progressive (46%), relapsed (35%) or persistent disease/refractory disease (19%). Median overall survival (OS) from the time of failure is 20 months; 35 patients (25.5%) are alive. One hundred and four patients received treatment; the response rate was 45%; complete remission in 41 (30%) and partial remission in 21 (15%) patients. 1st interventions post auto-SCT were chemotherapy (39%), radiation therapy (35%) or best supportive care (24%). Twenty-seven patients with 2nd-SCT (allogeneic (15), auto-SCT (2)) and/or brentuximab (18 patients) had superior OS (50.6 months) vs other treatments (22.5 months, P value 0.037). COX regression multivariate analysis identified post auto-SCT treatment failure before 12 months (hazard ratio (HR) 3.37, CI 1.7–6.6, P value < 0.001), presence of B symptoms (HR 2.55, CI 1.4–4.6, P value 0.002), stages III–IV (HR 2.7, CI 1.5–4.9, P value 0.001), albumin < 4 g/dl (HR 1.76, CI 1.1–2.9, P value 0.027) and tumor > 5 cm (HR 1.1.9, CI 1.13–3.25, P value 0.015) as significant risk factors; P value < 0.001. KM OS with 0–1 factor (148.6 months): 2 factors (23.6 months) and 3–5 factors (9.4 months) (P value < 0.001). OS was 63%:25%:7% respectively with 0–1:2:3–5 factors respectively (P value < 0.001). Despite high-risk factors, 2nd-SCT/brentuximab use post HDC auto-SCT failure may result in durable survival.

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Acknowledgments

We appreciate Ms. Ruqaya Belkhedim, Mr. Fayez Abu Zeid, and Ms. Reena Ulahannan from BMT clinic, Mr. Edgardo Colcol, Riad Youniss and Dr. Abida Rehman from Oncology Research Unit, Ms. Iman Youssef, clinical nurse coordinator for their valuable contribution and Sidrah Syed for proofreading.

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Authors and Affiliations

  1. Oncology Center, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, MBC# 64, Riyadh, 11211, Riyadh, Kingdom of Saudi Arabia

    Mahmoud A. Elshenawy, M. Shahzad Rauf, Tusneem A.M. Elhassan, Irfan Maghfoor & Saad Akhtar

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  1. Mahmoud A. Elshenawy
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  2. M. Shahzad Rauf
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  3. Tusneem A.M. Elhassan
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  4. Irfan Maghfoor
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Contributions

ME and SR helped in analysis of data and manuscript writing, TAME performed statistical analysis and helped in manuscript writing, IM was the co-principal investigator, helped in data interpretation, analysis and in manuscript writing, SA was the principal investigator, analysis of the data and takes primary responsibility for the paper. MAE is also a lecturer of Clinical Oncology, Faculty of Medicine, Menoufia University, Egypt.

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Correspondence to Saad Akhtar.

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Elshenawy, M.A., Shahzad Rauf, M., Elhassan, T.A. et al. Survival analysis of patients with Hodgkin lymphoma who failed high dose chemotherapy and autologous stem cell transplant. Ann Hematol 97, 1229–1240 (2018). https://doi.org/10.1007/s00277-018-3283-z

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  • DOI: https://doi.org/10.1007/s00277-018-3283-z

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